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Head Lice Management Guidelines Child, Youth and Family Community Health September 2016

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Page 1: Head Lice Management Guidelines - School District 61 ...€¦ · Head lice are spread by direct head-to-head contact with someone who has head lice, or to a lesser extent by sharing

Head Lice Management Guidelines

Child, Youth and Family Community Health September 2016

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Head Lice Management

Island Health

Table of Contents

Introduction .......................................................................................................................................2

Island Health Position Statement ......................................................................................................3

Appendices

What Parents and Caregivers Can Do, What the School Can Do, What the Public Appendix A Health Nurse Can Do .....................................................................................................4

Head Lice Facts ..............................................................................................................5 Appendix B

A Word on Combs .........................................................................................................6 Appendix C

Wet Combing ................................................................................................................7 Appendix D

How to Get Rid of Head Lice: Wet Combing ................................................................8 Appendix E

Medicated Head Lice Products .....................................................................................10 Appendix F

Head Lice Awareness School Newsletter Insert ...........................................................11 Appendix G

Reasons Treatment May Not Have Been Effective .......................................................12 Appendix H

Treatment Not Currently Recommended .....................................................................14 Appendix I

Resources ......................................................................................................................15 Appendix J

Contact Information ...........................................................................................................................16

References .........................................................................................................................................17

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Introduction

Head lice are common, especially among children between the ages of 3 to 12.

Head lice do not spread any diseases, but itching can develop in infested

individuals. Personal hygiene or cleanliness in the home, school, or community

has nothing to do with getting head lice. Anyone who has hair can get head lice.

Head lice cannot hop or fly; they are primarily transmitted when the head of an

infested individual comes in direct contact with the head of another. The

identification, management and treatment of head lice shall be a cooperative

endeavour between the family and the school community with primary

responsibility of checking and treatment resting with parents or caregivers. At all

times, schools must safeguard the protection of privacy of students. It is

important to protect the privacy of students with head lice as reactions can

significantly interfere with a child’s emotional well-being, social status in the

classroom and ability to learn.

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Island Health Position Statement

Island Health recommends children continue to be included in all school activities when lice is suspected or confirmed.

Rationale:

Lice may be present on the scalp for weeks before they are discovered. Children are often in the school

for days or weeks before head lice are detected; therefore there is no benefit to school exclusion.

Island Health recommends head lice screening be performed in the home by the family using the wet combing method to improve accuracy and maintain confidentiality.

Rationale:

Lice can be spread among students at school screenings by checking students one after the next.

Heads should be checked using the wet combing method which is not practical in a school setting.

Live lice move very quickly on dry heads and can be easily missed on a dry head check.

The presence of nits does not indicate an active infestation.

It is difficult to differentiate between nits and empty egg casings.

Fluff or dandruff in the hair is often mistaken for nits leading to high rates of misdiagnosis.

A misdiagnosis leads to unnecessary use of chemical head lice products (pediculocides).

Overuse of chemical head lice products can be hazardous to a child’s health.

Overuse of chemical head lice products can lead to lice that are resistant to the products.

Less than 50% of individuals scratch their scalp when they have head lice.

Even under ideal conditions, 10-30% of nits do not hatch.

Children identified as having head lice may be subjected to teasing and bullying.

Island Health recommends families are informed of the benefits and risks of treatment methods.

Rationale:

There are various treatments available to treat head lice.

Treatments range in efficacy, barriers, and potential side effects.

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Appendix A

What Parents and Caregivers Can Do…

Learn how to check for live lice using wet combing and be aware of the recommended treatment

options (Appendix D and E).

Check the heads of all family members for head lice weekly using the wet combing method.

It is possible to have head lice more than once; therefore weekly wet combing checks help

identify head lice re-infestations.

If live lice are found using the wet combing method, treat only family members with live lice.

Encourage your children not to share hair accessories, hats, combs, brushes, or anything that comes

in contact with your child’s head.

Remind family and friends about the importance of routine head checks.

Tie back long hair to help avoid getting head lice.

What the School Can Do…

Prevention

Include the School Newsletter Insert regularly in parent communication

(Head Lice Awareness School Newsletter Insert)(Appendix F)

Provide Wet Combing handout (Appendix D)

Provide information about head lice and head lice management during kindergarten

orientations

Additional cleaning in the school is not required. Lice that come off the head are either already

dying and have fallen off or they are injured and cannot hold onto hair anymore. (Devore et al. 2015

& Pontius, 2014)

What the Public Health Nurse Can Do…

In the school: Discuss management of head lice in collaboration with the school principal, staff and parents as

needed.

Provide online and/or print resources to support head lice prevention and treatment as needed.

Island Health Public Health Unit Contact Information www.viha.ca/locations/health_units/

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Appendix B

Head Lice Facts Adapted from the Canadian Pediatric Society Position Statement (Canadian Paediatric Society 2008)

Head lice are wingless, 2 mm to 4 mm long (adult louse), six-legged, insects that live and feed on the

scalp of humans. They do not jump or fly. They do not carry or spread disease. Head lice are not a sign

of poor hygiene.

A child usually carries fewer than 20 mature head lice, each of which, if untreated, live for 3 to 4 weeks.

Head lice stay close to the scalp for food, warmth, shelter and moisture. Head lice can move quickly on

dry hair, so they are difficult to see. The head louse feeds every 3 hours to 6 hours by sucking blood and

simultaneously injecting saliva. These bites can sometimes make the scalp itchy.

After mating, the adult female louse can produce 5 to 10 eggs per day for 30 days, each in a shell (a nit)

that is “glued” to the hair shaft near the scalp. The eggs hatch 6 to 12 days later into nymphs that molt

several times over the next 7 to 15 days to become adult head lice. The hatched empty eggshells (nits)

remain on the hair, but are not a source of re-infestation. Nymphs and adult head lice can survive for up

to 3 days away from the human host.

Head lice are spread by direct head-to-head contact with someone who has head lice, or to a lesser

extent by sharing combs, brushes or hats.

Adult lice live about 30

days and lay 5 to 10 eggs

each day.

Egg is glued to the hair

close to the scalp.

Nymph hatches in 6 to

12 days.

Reaches adult stage

in 7 to 15 days.

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Appendix C

A Word on Combs Regular combs will not remove head lice and nits. Lice combs have more space between the teeth than nit combs. Ideal lice combs have teeth

beveled at the end to ensure they can rest flat on the scalp. The teeth of the comb should be just wider than the hair (Handbook of the Non Drug Intervention [HANDI] Project Team, 2013) with less than 3mm between the teeth (Bohl B, 2015).

Nit combs’ teeth have less space between the teeth and are not necessary for wet combing. Nit combs may make the process of wet combing more challenging.

Plastic combs must have all the teeth present and straight, otherwise lice are bypassed as the broken comb is dragged through the hair.

Metal combs may barb and pull out hair. There is a lack of research regarding effectiveness of “zapper combs”, i.e. Robicomb. Combs are available at some public health units and pharmacies.

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Appendix D

Wet Combing This method is recommended to check everyone in the household weekly for head lice. Current research supports this as the most effective method to identify head lice (Goldstein & Goldstein 2015; Kurt et al. 2105; Simmons, 2015; Jahnke et al. 2009). Additional information on the Wet Combing technique is available in Appendix D. Wet combing is recommended as a way to manually remove live lice, breaking their life cycle and ending the infestation (Ibarra 1992; Ibarra, 1995; Hill, Moor et al. 2005). By combing out the live lice every 3-4 days, any newly hatched louse will be removed before it is able to reach adulthood and lay more eggs.

Advantages: Safe for all ages Non-toxic (does not contain insecticide) Suited to use with individuals with asthma and scalp wounds Safe for women who are pregnant and/or breastfeeding Affordable Easily incorporated into basic hygiene practices Benefit of parent and child spending time together This method has no possibility of resistance developing

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Appendix E

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Appendix F

Medicated Head Lice Products

Only treat family members where a live louse was seen during wet combing.

Chemical treatments are made to kill head lice and may or may not kill eggs. Resistance has made

many medicated insecticide products less effective in recent years when used alone. (Bohl et al.,

2015; Diaz, 2015; Gellatly, 2016; Greener, 2016; Wadowski, 2015; Yoon, 2014)

To minimize body exposure to a topical insecticide following application to the scalp, rinse well using

cool water taking care to avoid unnecessary skin exposure to the product – do not sit the child in the

bath water as the hair is being rinsed (Canadian Paediatric Society, 2008). If you choose to use a

chemical head lice product, ensure all the conditioner and hair product has been thoroughly washed out

of hair.

As many of the chemical lice products are different, the following are important to ensure proper use:

1. Ask a pharmacist for guidance with head lice products.

2. Follow the instructions on the box.

3. Be sure to check the box for the number of treatments required.

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Appendix G Head Lice Awareness School Newsletter Insert

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Appendix H

Reasons Treatment May Not Have Been Effective

Wet Combing

Sufficient conditioner is required for effective treatment.

The entire head needs to be combed through with a lice comb in small sections.

The comb must be wiped off or rinsed after every pass through the hair to remove lice.

A lice comb with teeth spaced just wider than the hair shaft is needed to remove all lice.

The comb needs to maintain contact with the scalp for each pass through.

The entire process must be repeated every 4 days for at least 2 weeks to remove all lice.

If live lice are found on the 4th combing at 2 weeks, add an additional combing 4 days later.

Medicated Products

The head lice may be resistant to the chemical product. (Use Wet Combing Method to look for lice.)

Documented cases of resistance to some chemical products have been documented across

Canada, in up to 97% of head lice (Yoon, 2014).

If live lice are still active on the head after properly using medicated product, lice may be

resistant.

If lice are resistant, use the wet combing method to remove lice.

Hair was wet. Some products are only effective when applied to dry hair.

Head lice close their breathing holes when exposed to water; therefore the chemicals can’t

penetrate and kill lice.

Hair had not been recently shampooed or had styling product in it. The head lice products require

hair that is clean and absent of product prior to treatment.

Conditioners, shampoos with built-in conditioner, and hair product (gel, spray, etc.) can coat the

hair and make it more difficult for chemicals in the medicated shampoo to work properly.

Sufficient product was not applied to thoroughly cover all hair. To increase effectiveness, comb

product through.

Thicker, longer hair will need more product.

Ensure all hair at the neck and behind ears are covered.

Head lice product was rinsed too early. Leave product on as long as recommended but no longer

(consult product box).

The eggs weren’t removed while using chemical products.

No product is 100% effective.

Remaining eggs can hatch in 6-12 days.

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The head lice product is too old.

Check expiry dates.

The active chemicals in products may weaken over time.

The second medicated product was not provided in the required 7-10 days.

No product kills 100% of eggs, and eggs hatch in 6-12days.

Misdiagnosis

There may not have been live head lice. Fluff and dirt are often mistaken for head lice, and an itchy

scalp may be due to other causes.

Another infestation (re-infestation) has occurred after treatment

Re-infestation results from head to head contact with a person who has lice.

If hair is clear 10 days after treatment, then head lice are found later, re-infestation has probably

occurred.

Consider talking to others to see if they have checked their families for head lice.

If you suspect re-infestation, ensure all members of your household are checked using the wet

combing method and treated for head lice on the same day.

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Appendix I

Treatments Currently Not Recommended

The following are not safe and do not work:

Insect Sprays

Motor oil

Gasoline

Alcohol

Flea soap

Dyes

Bleaches

Chinese Chalk Insecticide

WD40

Kerosene

The following do not have enough scientific evidence to support use;

therefore not recommended:

Olive oil

Vinegar

Mayonnaise

Melted butter

Margarine

Vaseline

Robi Comb

Follicel

Cetaphil

Shaving gel

Hair gel

Heat applied to the scalp

Garlic

Essential Oils (i.e. Pine, Tea Tree, Thyme, Rosemary, Eucalyptus, Chick Chalk, etc.)

Shaving the head

Heated air

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Appendix J

Resources

HealthLink BC Files: Head Lice (Aug 2014)

www.healthlinkbc.ca/healthfiles/pdf/hfile06.pdf

BCCDC A Quick Guide to Common Childhood Diseases

www.bccdc.ca/resource-

gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/Other/Epid_G

F_childhood_quickguide_may_09.pdf

Canadian Paediatric Society Position Statement

www.cps.ca/documents/position/head-lice

Island Health Healthy Schools Initiatives

www.viha.ca/children/school_years/healthy_schools/

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Contact Information

Campbell River Health Unit 200-1100 Island Highway Campbell River, BC V9W 8C6 Phone: 250.850.2110

Nanaimo - Princess Royal Family Centre (Public Health) 260 Irwin Street Nanaimo, BC V9R 4X5 Phone: 250.739.5845

Saanich Health Unit 3995 Quadra Street Victoria, BC V8X 1J8 Phone: 250.519.5100

Comox Valley Health Unit 961 England Avenue Courtenay, BC V9N 2N7 Phone: 250.331.8520

Nanaimo - Communicable Disease Program Beaufort Centre 8-1599 Dufferin Crescent Nanaimo, BC V9S 5L5 Phone: 250.740.2616

Salt Spring Island Health Unit #1 - 137 Crofton Road Salt Spring Island, BC V8K 2R8 Phone: 250.538.4880

Duncan Health Unit / Margaret Moss Health Unit 675 Canada Avenue Duncan, BC V9L 1T9 Phone: 250.709.3050

Oceanside Public Health Services (formerly Parksville/Qualicum Health Unit) PO Box 339, 494 Bay Avenue Parksville, BC V9P 2G5 Phone: 250.947.8242

Sooke Health Unit #104 – 6672 Wadams Way Sooke, BC V9Z 0H3 Phone: 250.642.5464

Esquimalt Health Unit 530 Fraser Street Victoria, BC V9A 6H7 Phone: 250.519.5311

Peninsula Health Unit 2170 Mount Newton X Road Saanichton, BC V8M 2B2 Phone: 250.544.2400 Outer Gulf Islands Toll-free Phone: 250.539.3099

Tofino and Ucluelet Public Health Coastal Family Place 265 First Street, PO Box 1078 Tofino, BC V0R 2Z0 Phone: 250.725.4020

Gold River Health Centre 601 Trumpeter Drive Gold River, BC V0P 1G0 Phone: 250.283.2626 ext. 3

Port Alberni Public Health Services 4227 6th Avenue Port Alberni, BC V9Y 4N1 Phone: 250.731.1315

Tuberculosis Prevention & Control Office 1952 Bay Street Victoria, BC V8R 1J8 Phone: 250.519.1510

Ladysmith Health Unit 1111-4th Avenue, PO Box 10 Ladysmith, BC V9G 1A1 Phone: 250.739.5777

Port Hardy Health Unit 7070 Market Street Port Hardy, BC V0N 2P0 Phone: 250.902.6071

Victoria Health Unit 1947 Cook Street Victoria, BC V8T 3P7 Phone: 250.388.2200

Lake Cowichan Health Unit 58 Cowichan Avenue W PO Box 590 Lake Cowichan, BC V0R 2G0 Phone: 250.749.6878

Port McNeill Health Unit 1775 Furney Place Port McNeill, BC V0N 2R0 Phone: 250.956.4711

West Shore Health Unit 345 Wale Road Victoria, BC V9B 6X2 Phone: 250.519.3490

Nanaimo Health Unit (Public Health) 1665 Grant Avenue Nanaimo, BC V9S 5K7 Phone: 250.755.3342

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References BC Centre for Disease Control. (2009). A quick guide to common childhood diseases. Retrieved from

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Birkenmoe, T., Lindstedt, H. H., Ottesen, P., Solong, A., Naess, O., & Rukke, B. A. (2016). Head lice predictors and infestation dynamics among primary school children in Norway. Family Practice, 3(1), 23-29. doi:10.1093/fampra/cmv081

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Frankowski, B., & Bocchini, J. A. (2010). Clinical Report-Head Lice. American Academy of Pediatrics, 126(3), 392-403. doi:10.1542/peds.2010-1308

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